D22现场检验调查表

1、v1.0可编辑可修改辽宁省医疗器械检验所现场检验条件调查表Questi onn aire on Testi ng Spot1. 基本情况(Basic Condition )制造商名称:Manu facturer:生产厂地址：Address:产品名称：Name:型号规格：Model:商标名称：Trade mark:11真实性承诺：我们承诺现场检验条件调查表中填写内容真实无误，若有不符，承担由此而产 生的一切责任和后果。Authe nticity Promise:We promise that “ Questi onn aire on Testi ng ” we filled in is trul

2、y and in errable. If it does n ot truly with the form, we will take the resp on sibility for all the legal issue occurred.填表人签字：印刷体Filled by:Print :批准人签字：印刷体Approved by:Print :(公章）年月日(Seal)date:LMTI-QSD-D222A-S02. 试验现场条件(Testi ng Spot Con dition)X射线机（CT机）试要求：现场试验的场地及相关的电源、通风、照明、电离辐射防护等条件应满足 验的要求。Req

3、uireme nt: The con diti ons of test ing spot on the site, supply, ven tilate, lighti ng,ioni zati onradiati onprotecti onshould meet the testingrequirementsof X-ray equipment C T.试验场地名称及地点： The n ame and address of test ing site:工作面积：m 2状态：口独立口局部Work ing areaStateIn depe ndence Part环境温度： C相对湿度： %空调口

4、自然状态En vir onment temperatureRelative humidity Con diti onerNature con diti on通风状况：空调口自然通风Ven tilated con diti on Con diti onerNature照明状况：口人工采光口自然采光Light ing con diti onSuppl ying lightNature light电源条件：相数：口单相口三相电源电阻：QSupply con diti on Phase sin gle phaseTriphase Power resista nee电压： V频率： Hz容量：kWVol

5、tageFreque ncyElectrical capacity电磁干扰的防止：无干扰源有干扰源Electromag netic in terfere nee preve nti on No-i nterfere neeIn terfere nee有干扰源，但有防止措施In terfere nee, but has preve nti on method振动噪音的防止：口无噪声源口有噪声源Vibrati on no ise preve nti onNo-no iseNoise有噪声源、但有改善措施Noise, but has improvable method保护接地的条件：口有专用接地系统

6、口有临时接地系统Protective earthi ng con diti onSpecial earth ing systemTemporary earth ingsystem无接地系统No- earth ing system电离辐射的防护：永久性防护（隔室操作）临时防护（防护屏）loni zati onradiati onprotect ionPerma nenceprotect ion Temporaryprotect ion无辐射防护No-radiati on protect ionLMTI-QSD-D222B-S03. 试验辅助人员（Testi ng Assista nt ）要求：应

7、有熟悉标准、检验操作的专业技术人员协助工作。Requireme nt: Tech ni calstaffs who are familiar with the sta ndard and test should assist withthe work .名称性别职务/职称专业从事专业年限NameSexTitleMajorYears at this field4. 试验仪器设备(Testi ng In strume nts)要求：应提供试验所需要的仪器设备。Requireme nt: The in strume nt should be supplied for testi ng require

8、me nt.仪器设备名称Name of in strume nt要求Requireme nt型号Model量程及准确度Measuri ng range andaccuracy计量有效期Calibrati onPeriod ofValidity温度计Thermometer用于环境温度监测湿度计Hygrometer用于环境湿度监测频率计Freque ncy meter用于网电源监测电源电阻表Resista nee meter(IEC 601-2-7)电压表、电流表Voltmeter 、current-meter(IEC 601-1)潮湿预处理设备In strume nt for humidity

9、prec on diti oning treatme nt(IEC 601-1)仪器设备名称Name of in strume nt要求Requireme nt型号Model量程及准确度Measuri ng range andaccuracy计量有效期Calibrati onPeriod ofValidity剩余电压测量仪器In strume nt for measuri ngresidual voltage(IEC 601-1)15剩余能量测量仪器In strume nt for measuri ngresidual en ergy(IEC 601-1)15接地电阻测量用仪器In strum

10、e nt for measuri ngearth ing resista nee(IEC 601-1)18漏电流测量用仪表In strume nt for measuri ngleakage curre nt(IEC 601-1)19漏电流测量用隔离变压器Isolate tran sformer for measuring leakage current(IEC 601-1)19电介质强度测量设备In strume nt for measuri ngDielectric stre ngth(IEC 601-1)20测量用压板(625ml2)Measuri ng board( 625mrf)(I

11、EC 601-1)21a)测量用压板（）Measuri ng board （）(IEC 601-1)硬木板Hardwood(IEC 601-1)仪器设备名称Name of in strume nt要求Requireme nt型号Model量程及准确度Measuri ng range andaccuracy计量有效期Calibrati onPeriod ofValidity5。和10。斜面(IEC 601-1)245° and 10° inklinedplane(IEC 601-2-32)扭矩试验装置Torque test apparatus(IEC 601-1)标准试验指S

12、tan dard test fin ger(IEC 601-1)16(图 7)试验针Test pin(IEC 601-1)16(图 8)试验钩Test hook(IEC 601-1)16(图 9)试验棒Test rod(IEC 601-1)16b)冲击试验装置Impact test apparatus(IEC 601-1)21(图 G1)X射线剂量仪（测试半价层、 线性、重复性、稳定性）X-ray dosimeter(IEC601-1-3)601-2-7)标准铝板Stan dard Alumi nium layer(IEC601-1-3)仪器设备名称Name of in strume nt要求

13、Requireme nt型号Model量程及准确度Measuri ng range andaccuracy计量有效期Calibrati onPeriod ofValidity射线剂量仪（测试漏射线）X-ray dosimeter(IEC601-1-3)X射线管电压表X-ray tube kV-meter(IEC 601-2-7)射线管电流表X-ray tube mA-meter(IEC 601-2-7)加载时间表Loadi ng timer(IEC 601-2-7)电流时间积表Current time productmeter(IEC 601-2-7)纯铝板Aluminium layer(IE

14、C 601-2-7)存储型示波器Memory oscillograph秒表Stop watch(IEC 601-2-7)(IEC 601-2-28)推拉式弹簧测力计Push and pull spri ngdyn amometer(IEC 601-1)21a)(IEC 601-2-32)、仪器设备名称Name of in strume nt要求Requireme nt型号Model量程及准确度Measuri ng range andaccuracy计量有效期Calibrati onPeriod ofValidity角度仪An guloometer(IEC 601-1)24长度尺Len gth

15、ruler(IEC 601-2-28)16铝箔men tal foil(IEC 601-1)19重物mass(IEC 601-1)试验角test corner(IEC 601-1)测温装置measuri ng temperatureapparatus(IEC 601-1)4)弯曲试验装置flex ing cord apparatus(IEC 601-1)电源变压器试验装置supply tran sformer testapparatus(IEC 601-1)电源变压器电介质强度试验 装置dielectric stre ngth of supply tran sformer test appar

16、atus(IEC 601-1)仪器设备名称Name of in strume nt要求Requireme nt型号Model量程及准确度Measuri ng range andaccuracy计量有效期Calibrati onPeriod ofValidity球压试验装置Ball-pressure testapparatus(IEC 601-1)1)高温箱high-temperature cab inet(IEC 601-1)1)高压电路电介质强度试验装置dielectric stre ngth test apparatus(high-voltage circuit)(IEC 601-2-7)20三种水模(自动曝光控制的稳定性)provisi on of pha ntoms ofthree differe ntthick nesses(IEC 601-2-7)密度计den simeter(IEC 601-2-7)毫欧表millimho meter(IEC 601-2-28)16aa)照度计